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AxisMD Advisory

@axismd_advisory

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Healthcare executive advisory.
Helping physicians protect independence & negotiate smart.
MSO · Practice Growth · M&A
Houston · Dallas · Nationwide

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“Our overhead is fine” is not a number.
Break it into categories. Benchmark each one separately.

Total overhead as a percentage of collections is a fine headline number and a poor management tool.

Two practices can land at the same total and be in completely different positions — one carrying heavy occupancy cost with a lean team, the other in cheap space and overstaffed. The fixes are opposites.

Break it into categories and benchmark each one separately: clinical and administrative staffing; occupancy (rent, CAM, utilities); medical and office supplies; malpractice; IT, EHR and practice management software; professional fees, billing service, and everything else.

Then look at trend, not just level. A category that’s grown three points over two years is telling you something the absolute number isn’t.

The category that surprises owners most often is IT/EHR — layered subscriptions, add-on modules, and portals that were bought for a specific reason years ago and never cancelled. #physicianownership #practicemanagement #physician #privatepractice #overhead by @axismd_advisory

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2 months ago

Your schedule template was built for a practice you no longer have.
Redesigning the template adds capacity without adding cost.

Most practice schedule templates were designed once, for a payer mix and patient population that has since changed, and then never revisited.

Three numbers tell you whether yours still fits:
1. Slot utilization. Of the appointment slots you built, what percentage were actually filled? If you’re consistently under, you’re staffing and leasing for capacity you’re not using.
2. No-show rate, segmented. Practice-wide no-show rate is not useful. No-show rate by day of week, time of day, appointment type, and payer is extremely useful — it tells you exactly where to overbook and where not to.
3. Same-day fill rate. When a cancellation comes in at 9am for a 2pm slot, how often does that slot get filled? If the answer is “rarely,” you don’t have a waitlist process, and that is a genuinely solvable problem.

Template redesign is one of the few operational changes that increases capacity without adding cost. #healthcareoperations #practicemanagement #scheduleoptimization #physicianownership #physician by @axismd_advisory

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3 months ago

When did you last actually read your biggest payer contract? 📄
If it auto-renews with no escalator, you’ve been eating inflation for years while your rates sat still.
Find the notice window. Put it on the calendar. That one step is the difference between practices that get increases and practices that don’t.

#independentpractice #physicianowner #practicemanagement #medicalpractice #healthcarebusiness by @axismd_advisory

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3 months ago

What Is a PE Partnership — Really?

Private equity comes knocking — but do you really understand what you’re signing?

A PE partnership isn’t just a liquidity event. It’s a restructuring of how your practice operates, who holds decision-making authority, and what your future compensation looks like.

Here’s what physicians often discover too late:

→ “Clinical autonomy” language varies widely by deal
→ Management equity may not vest the way you expect
→ EBITDA adjustments directly affect your valuation
→ Non-competes can follow you for years post-sale

Before you sign anything, you need an advisor who understands both the clinical side and the deal mechanics.

We help independent physicians evaluate PE offers with clear eyes — not just enthusiasm.

What questions do you have about PE partnerships? Drop them below.

#PhysicianAdvisory #PrivateEquity #PhysicianPractice #AxisMD #PracticeManagement HealthcareM&A IndependentPhysician by @axismd_advisory

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3 months ago

One of our co-founders was at her annual well woman exam this week when her OB/GYN mentioned something that stopped her cold.
He has a thriving independent practice — 4 physicians, financially viable, patients who love him. And he told her he’s planning to eventually sell to a large PE-backed MSO.

Not because it’s what he wants. Because he’s exhausted.

“My joy is being a physician,” he said. “Not an operator.”

We hear this more than you’d think. Incredible doctors — skilled, financially stable, genuinely loved by their patients — quietly burning out under the weight of running a business.

And too often, the only options they see are:
→ Sell to a large PE platform and become a number
→ Keep grinding through the operational burden alone

There’s a third option.

AxisMD was built for exactly this physician. We come in as your operational partner — handling the headaches so you can focus on what you actually trained to do. You set the level of involvement you want. You keep the autonomy that matters to you. You just stop carrying the parts that were never supposed to be yours.

Independent doesn’t have to mean alone.

If this sounds like you — or someone you know — we’d love to talk.

📩 sara@axismd.co | axismd.co by @axismd_advisory

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4 months ago

Something we’re incredibly proud to share.

AxisMD has officially launched a full MSO partnership with Sauna Therapy Studios @sauna.therapy — a Dallas-area mental health and wellness studio founded by Paige Swanson, LPC.

Paige has built something genuinely special: a healing environment offering psychotherapy, infrared sauna, and integrative wellness services, centered on the belief that therapy should feel as good as it works.

Our role as MSO partner is to build the business infrastructure that matches that vision — so Paige and her team can focus entirely on their clients.

What AxisMD is supporting:

🎨 Complete rebrand — in partnership with the talented @kimberlyanne42 of Kimberly Kleiser Design. The new identity is stunning: botanical, warm, and unmistakably premium.

📊 Financial systems — income statement rebuild, chart of accounts, pricing strategy, and revenue diversification planning

⚙️ Full operational infrastructure — workflows, roles, accountability systems, and onboarding frameworks

🤝 Therapist and client experience improvements — retention, satisfaction, and culture infrastructure that scales

This is exactly what MSO partnerships are designed to do: let exceptional clinicians do their best work, backed by a business that runs.

Welcome to the AxisMD family, Paige and the entire Sauna Therapy Studios team. We couldn’t be more excited for what’s ahead. 🌿✨

#AxisMD #SaunaTherapyStudios #MSOPartnership #PartnershipAnnouncement #HealthcareAdvisory WellnessBusiness DallasWellness MentalHealth KimberlyKleiserDesign Rebrand BusinessGrowth PracticeManagement by @axismd_advisory

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4 months ago

Without context, your numbers are just numbers. Benchmarking turns them into insight.

Here’s how to do it:

Use MGMA and AMGA data for specialty-specific benchmarks on productivity, comp, and overhead
Track wRVU output vs. the 50th and 75th percentile for your specialty
Know your compensation-to-revenue ratio relative to peers
Compare overhead ratio against specialty benchmarks — high overhead is usually a billing or staffing symptom
Monitor new patient rate monthly — referral channels show up here before revenue does

The goal isn’t to hit the median on everything. It’s to know where you are and make intentional decisions from there.

📩 axismd.co

#practicemanagement #physicianfinance #healthcarestrategy #mgma #practiceownership independentphysician axismd by @axismd_advisory

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4 months ago

Most physicians hand their P&L to their accountant once a year and move on.

That’s not financial management. That’s financial abdication.

5 things to read yourself — every month:

Gross charges vs. net collections — the gap tells you if billing is drifting
Fixed vs. variable costs — know what your practice costs at different volumes
Provider-level profitability — you should be able to see P&L by physician
Month-over-month trends — one month is noise, three months is a signal
Non-operating items — separate financing costs from true operating performance

If you can’t read your P&L, you can’t manage your practice — and you can’t negotiate a deal from strength.

📩 axismd.co

#practicemanagement #practiceownership #physicianfinance #healthcarestrategy #independentphysician medicalgroup axismd by @axismd_advisory

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4 months ago

If you’re only looking at your bank balance to gauge practice health, you’re flying blind.

6 metrics that actually tell the story:

Revenue per physician — benchmark against MGMA for your specialty
Overhead ratio — target 55–65% depending on specialty
Collection rate — below 95% means a billing audit is overdue
Days in AR — under 35 days is the benchmark for most specialties
Payer mix by revenue — payer mix shifts before revenue shifts
Cost per visit — flat or falling as volume grows = efficient scaling

Track these monthly. Problems that show up quarterly were visible monthly.

📩 axismd.co

#practicemanagement #practiceownership #physicianfinance #healthcarestrategy #medicalgroup independentphysician axismd by @axismd_advisory

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4 months ago

A 6x offer and an 8x offer aren’t as different as they look. Here’s why.

The multiple is applied to your adjusted EBITDA — not revenue.
Your specialty determines your multiple range more than your size does.
Platform practices get paid more than add-on practices.
Clean, consistent financials command a premium.
Rollover equity changes the whole deal structure.

The multiple is the headline. The real deal is in the details underneath it.

Before you evaluate any offer, make sure you understand what you’re actually comparing.

📩 axismd.co

#privateequityhealthcare #practicevaluation #ebitda #physicianfinance #healthcarema practiceownership axismd by @axismd_advisory

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5 months ago

Your PE deal said 7x. After QoE it came in at 6x. Here’s why that happens.

QoE — Quality of Earnings — is the independent financial review that normalizes your EBITDA before the deal closes.

5 adjustments that move the number most:

Owner compensation normalized to market rate
One-time expenses removed (legal, equipment, etc.)
Related-party transactions scrutinized
Revenue concentration flagged and discounted
Working capital peg applied at close

None of this is unusual. It’s standard. But walking into a transaction without knowing it’s coming is expensive.

Preparation matters more than the multiple.

📩 axismd.co

#privateequityhealthcare #qoe #practiceownership #physicianfinance #healthcarema axismd physicianentrepreneur by @axismd_advisory

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5 months ago

If a PE firm called you tomorrow, would you know your EBITDA?

Most physicians don't. That's an expensive gap.

EBITDA is the number buyers actually apply your multiple to. Not revenue. Not net income. EBITDA.

Here's what each letter means:

E — Earnings: net income as the starting point
B — Before Interest: debt structure stripped out
I — Taxes: removed for comparability
T — Depreciation: non-cash write-downs added back
A — Amortization: intangible assets written off over time, also added back

Why does this matter?

A 7x multiple on $1M EBITDA = $7M deal.
A 7x multiple on $800K EBITDA (after QoE adjustments) = $5.6M deal.

Same multiple. $1.4M difference.

Know your number before they do.

📩 axismd.co

#physicianfinance #privateequityhealthcare #ebitda #practiceownership #healthcarestrategy #physicianentrepreneur #axismd EBITDA explanation - why does it define your deal by @axismd_advisory

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5 months ago